Cochrane Elliott, Vollans Sam, Bourke Gráinne
Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals, Leeds, UK.
Department of Trauma & Orthopaedic Surgery, Leeds Teaching Hospitals, Leeds, UK.
Shoulder Elbow. 2023 Sep;15(1 Suppl):65-70. doi: 10.1177/17585732221089299. Epub 2022 Mar 29.
Nerve deficit following shoulder arthroplasty can cause significant morbidity. We examined the incidence and pattern of nerve injury following shoulder arthroplasty in a University Hospital.
Retrospective review of all patients undergoing shoulder arthroplasty over a five-year period (September 2014 to August 2019). Patients were identified using clinical codes and relevant data extracted by review of patient records. We excluded patients with preoperative nerve injuries.
220 arthroplasties were performed in 210 patients. The overall nerve deficit rate was 2.3% (5/220). Five nerve deficits occurred following reverse total shoulder arthroplasty (rTSA). In two patients, nerve recovery occurred within 12 months. Two patients had persistent deficits at 12 months. One patient had a deficit at seven months, but incomplete follow up. There was no clear documentation of discussions with clinicians specialising in nerve injury.
Nerve injury rates in our series for rTSA are low and comparable to systematic review data. We purport that for rTSA, adequate soft tissue releases, careful arm positioning and retraction alongside limiting over-lowering the centre of rotation may prevent nerve injuries. A postoperative nerve deficit should warrant an opinion from a specialist in nerve surgery with clear referral pathways to allow efficient access to services.
肩关节置换术后的神经功能缺损可导致严重的发病率。我们在一家大学医院研究了肩关节置换术后神经损伤的发生率和模式。
回顾性分析在五年期间（2014年9月至2019年8月）接受肩关节置换术的所有患者。通过临床编码识别患者，并通过查阅患者记录提取相关数据。我们排除了术前有神经损伤的患者。
210例患者共进行了220次关节置换术。总体神经功能缺损率为2.3%（5/220）。5例神经功能缺损发生在反式全肩关节置换术（rTSA）后。2例患者在12个月内神经功能恢复。2例患者在12个月时仍有持续性缺损。1例患者在7个月时有缺损，但随访不完整。没有关于与神经损伤专科临床医生讨论的明确记录。
我们系列研究中rTSA的神经损伤率较低，与系统评价数据相当。我们认为，对于rTSA，充分的软组织松解、小心的手臂定位和牵开以及限制过度降低旋转中心可能预防神经损伤。术后神经功能缺损应由神经外科专家给出意见，并应有明确的转诊途径，以便能有效获得相关服务。
